Provider Demographics
NPI:1356453617
Name:SANDONA, CYNTHIA (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:SANDONA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 204 N
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-478-7767
Mailing Address - Fax:248-478-5727
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:SUITE 204 N
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:248-478-7767
Practice Address - Fax:248-478-5727
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011366208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0256302775OtherBLUE CROSS OF MI
MIOM25740OtherMEDICARE RAILROAD
MI3243601Medicaid
MIOM25440Medicare PIN
MI0256302775OtherBLUE CROSS OF MI